A Plea for Health Manpower Training Through Distance Education*Prof. P.K. Dutta, Dr. T.K. Jena, Dr. S.K. Panda, Indira Gandhi National Open University
Distance education is a relatively new concept which not only has the ability to train a large number of health care workers in a short time in a cost effective way but can also attend to skills of health care without diluting the quality. The School of Health Sciences, IGNOU, is, at present, working on two health programs for nursing and medical personnel through distance education. Alternate models in distance education could also be envisioned to meet the immediate pressing needs. India, like many other countries, is committed to the Alma-Ata declaration of 1978 to provide Health for All by 2000 AD (HFA/2000). Training of health workers is an essential prerequisite for the achievement of the goals of HFA/2000. In most of the dev v v veloping countries, HFA has been a serious concern, and strategies are being constantly designed and tried out to keep pace with the changing health scenario. In India, both the government as well as the health administrators have expressed their serious s s s concern about adopting alternative strategies for achieving this gigantic task of HFA by 2000 AD. Need for Training of Health Professionals In a developing country such as India, where an optimal level of health service is a dream to many, there are far too few health workers in training and the number of training institutions is far too few. To understand the gravity of the situation, ther r r re are more than 365,000 doctors, 264,000 nurses and 350,000 allied health professionals which includes Multipurpose Health Workers, Village Health Guide, etc. Whereas, proper training facilities exist only at a few institutions like National Institute of Health and Family Welfare (NIHFW), State Health and Family Welfare Training Centers. With a limited number of available training institutions, it is nearly impossible to train large numbers of medical officers and paramedical workers. Medical education in India is based largely on the western model and unfortunately, both undergraduate and postgraduate curricula fail to match local health needs. Thus, products of such a system are mismatched with the existing expectations of the work kplace and find it difficult to tackle many problems in their work situations. The Government of India has been organizing periodical short-term training programs for government health functionaries in order to provide continuing education with emphasis on achieving the goals of HFA. These, however, are poorly attended. Nearly 47 Health and Family Training Centers (HFWTC's) and seven Central Training Institutes (CTIS) provide health and family welfare training to all categories of health functionaries in the country. These long-duration training programs attract a limited number of clients, and hence most of the institutions also organize in-house short-term training programs which has less than the desired impact on their functionaries. Distance Education for Health Professionals' Training The increasing requirements for health services and corresponding need for a large number of health workers, as well as the necessity of continuing education of professionals have led to the application of distance teaching-learning in the health sector. While developed in the sixties, even after three decades, only a few countries have initiated distance education for training. In the mid-sixties, a distance learning program for family physicians and various categories of nurses was initiated in Australia and The United States (Texas). The Welcom Tropical Institute implemented a distance education program on various diseases using a problem based approach in a few African countries including Kenya, Sudan and Tanzania; more are being offered at the University of Dundee, Scotland. In the nineties, a few other countries have initiated health education and training programs at a distance. (2) In India, health courses offered through distance education are few and offered by a limited number of institutions such as the National Institute of Health and Family Welfare. Examples include a 1991 course on Health and Family Welfare Management for D D D District Health Officers; Christian Medical College, Vellore (PG Diploma as well as M.Phil. in Hospital Administration) in collaboration with BITS, Pilani, Rajasthan and Tulane University (USA) (3); Christian Medical Association of India (a 1993 program for trainers of a two year laboratory technician training course). In July 1994, the Indira Gandhi National Open University launched a B.Sc. Nursing program for inservice diploma holder nursing professionals. A PG Diploma in Maternal & Child Health (DMCH) for medical officers/private practitioners in collaboration with the World Health Organization is under preparation and will be launched in 1997. Strategies for Training Through Distance Education Distance education systems have emerged the world over to meet the growing demand for education, including professional education, to provide opportunities at a comparatively low cost, and meet the continuing education needs of professionals and various other functionaries. The methodology of distance teaching-learning often involves a multi-media approach to design, develop and implement independent learning programs through self-instructional materials, both in print and electronic media forms. Distance study allows self pacing for convenience and also facilitates learners having control over their learning. The various media used for distance education delivery include among others, print materials, audio and video programs, radio and television programs, tutoring and counseling, field visits, laboratory practicals, extended contact programs, and teleconferencing. Challenges and Issues For effective and efficient health care delivery, especially in rural areas and urban slums, inservice and refresher training of various categories of medical and paramedical workers has always been emphasized by health administrators. As of late, they have posed faith in the efficacy of distance learning for such a task. (3) It was only in the mid-eighties that distance education in the health sector began to be implemented in the countries of the developing world. Though, as noted above, a few count tries including India have initiated distance professional health education, there is not adequate data to assess its impact of the programs at this time. It is still our belief that the most important challenge of training and reorientation of middle and junior level health workers of government organizations and NGOs can be best met through open distance learning programs. Application of modern communication technology would be extremely useful and cost-effective in achieving the training targets within stipulated time frame. The future challenge includes provision of qualitative need-based health education and training programs to a variety of heterogeneous clients. However, certain issues need to be addressed and considered for successful application of distance education programs for health professions: 1. Since health sciences deal with life and death and are therefore are more skill-oriented (rather than more knowledge-based), it is felt that providing basic beginning or early training in the field of health may not be feasible through distance learning. Being an innovative and flexible system, and having the ability to respond to emerging training and educational needs, distance education is more appropriate for inservice training of health personnel. 2. The academic programs have been confined to a limited area of health education and training. In order to meet the diversified and emerging needs of health workers, the programs and courses have to go beyond medical graduates to include a wide variety of need-based functional areas ranging from simple awareness programs to more complicated skill-oriented courses on epidemiology and health economics. 3. Application of sophisticated communication technology has to be done cautiously, keeping in view clients needs, cost, media behavior and infrastructure and facilities at the receiving end. In the developing countries including India, audio and television programs seem to be more feasible and promising. Furthermore, multi-media packages need to include a large amount of hands-on and field experience. 4. An issue to be deliberated is the provision of student support services for health workers and professionals. While compulsory counseling and extended contact increase the effectiveness of programs, these on the other hand pose problems to both providers as well as the receivers of health education. More practical-oriented courses need to have compulsory built-in face-to-face components; and work centers or practice centers at grassroots level with required instructional provisions would be more feasible than regular study centers. In conclusion, it is worth noting that distance education has tremendous potential for providing education and training programs to different categories of medical and paramedical personnel as a means of helping achieve the goals of HFA. In addition to the national agencies such as the Ministry of Human Resources Development, the Ministry of Health & Family Welfare and Indira Gandhi National Open University, international agencies such as WHO and UNICEF need to play increasingly prominent roles in facilitating the achievement of national and institutional targets. References 1. Ministry of Health & Family Welfare (1991) Health Information of India, CBHI, DGHS, MHFW, New Delhi. 2. Rumble, G. and Olivera, F. (eds) (1992) Vocational Education at a Distance, London: Kogan Page. 3. Varghese B, Pulimood BM Senguttavan MC. An Innovative Distance Education and Program for Hospital Managers, IJOL 1993; 2(1):1-5. Prof. (Col.) Dutta is Director, School of Health Sciences, Indira Gandhi National Open University, Maidan Garhi, New Delhi India. - 1100068 Dr. T.K. Jena is Lecturer, School of Health Sciences, Indira Gandhi National Open University, Maidan Garhi, New Delhi India. - 1100068 ,strong>Dr. S.K. Panda is Director, Association of Indian Universities, Bahadur Shah Zafar Marg, New Delhi - 110002 Dutta PK, Jena TK, Panda SK. A Plea for Health Manpower Training Through Distance Education. Med Educ Online [serial online] 1996;1:8. Available from: URL http://www.Med-Ed-Online.org. |
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